MALIGNANT Lesions

MALIGNANT Lesions - Tumours of the Jaws Tumours Malignant...

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Unformatted text preview: Tumours of the Jaws Tumours Malignant Tumors Malignant Tumor: – Is a mass of cells, tissues or organs resembling those normally present but arranged atypically and behave abnormally. Behavior is very essential and is of great importance. Malignant Tumors Malignant Classification: – Histogenetic: Epithelial origin connective tissue connective origin origin – Histological: Degree of differentiation. – – – Well Well moderate moderate poorly differentiated Malignant Tumors Malignant – Clinical behavior: Clinical Benign: Benign – slowly growing and expanding causing pressure atrophy slowly but remain within the capsule. – Very few mitosis could be seen. Very Malignant: Malignant: – Invade surrounding tissues and locally invasive. – Progressive growth and metastasize to distant organs, Progressive embolic spread due to lack of cell adhesion – Mitosis. Intermediate: – Locally invasive, no metastasis. Basal cell carcinoma Locally and Ameloblastoma and Malignant Tumors Malignant Oral lesion are: – Carcinomas: Non‑secreting epithelial Non‑secreting – Squamous cell 90% Secreting epithelial – Adenocarcinoma 5% 5% – Sarcomas: Lymphomas Others Malignant Tumors Malignant Early diagnosis is very essential for management Clinical diagnosis from the signs and symptoms Referral for essential investigation Malignant Tumors Malignant CLINICAL DIAGNOSIS OF ORAL CANCER – Symptoms vary according to the site of the lesion painless in the early stages painful and tender when secondarily infected or involves painful a sensory nerve sensory painless lump or ulcer on the lip Posteriorly no symptom until it reach a size of 2‑3 cm Posteriorly swelling, swelling, – pain and difficulty in deglutition absence of symptoms until the tumor metastasize to absence regional lymph nodes – hard lump on the neck hard Malignant Tumors Malignant llate symptoms: ate – pain due to secondary infection or nerve pain involvement involvement – excessive salivation – difficulty in deglutition, speech difficulty – haemorrhage Within bone: – painless swelling involving the buccal and lingual or painless palatal sulci – teeth become loose and painful ‑acute alveolar abscess abscess – edentulous pt. the denture does not fit edentulous – denture hyperplasia – anaesthesia of the upper or lower lip and the cheek. Malignant Tumors Malignant Carcinoma of lip: age 50‑70 years. Male age lower class. lower – Predisposition factor: dirty, jagged and stained dirty, teeth teeth irritation. tobacco smoker tobacco leukoplakia. leukoplakia. iintense solar radiation ‑ ntense blistering cheilitis due to sunshine. sunshine. Lower lip affected in 93% 93% Upper lip affected in 5% Angle of mouth affected Angle in 2% in Metastases within a Metastases year ‑ submental, submandibular and upper jugular. D.D.: D.D.: – Molluscum pseudo­ carcinomatosurn lower lip. Death due to infection and Death bronchopneumonia. bronchopneumonia. Malignant Tumors Malignant Carcinoma of tongue Carcinoma tongue Anterior 2/3, affect males Anterior Posterior 1/3 equal in both sexes. Age over 60 years. – Predisposing factors: Female with cancer tongue suffer from Paterson‑Kelly Female syndrome. syndrome. Bad oral hygiene Heavy alcoholic with element of Vit.B deficiency. Producing Heavy precancerous mucosal atrophy precancerous Syphilitic and leukoplakia. 25% and 5%. Syphilitic Superficial glossitis, papilloma, fissures and non‑specific ulcers. ulcers. Malignant Tumors Malignant Site & Types: – – – – 1. lateral edge of tongue 58% 2. tip of tongue 2‑4% 3. dorsum. of tongue 7‑15% 4. posterior 1/3 21‑33% 1. ulcerative 2. fissured malignant 3. papillary 4. flat nodules 5. scirrhous or atrophic type Malignant Tumors Malignant Clinically: – Painless swelling Painless – Painful infected ulcer, referred pain to the Painful ear. ear. – Excessive salivation, marked factor oris, Excessive haemorrhage – lloss of mobility due to fixation to the floor oss of the mouth. Malignant Tumors Malignant – Fixation occur at first on one side, when tongue is Fixation protruded it deviate toward the affected side protruded – iindurations, fungation or ulceration which spread ndurations, to the floor of the mouth and alveolar process and from post. 1/3 to the fauces, valleculae and epiglottis bilaterally. epiglottis – Spread to regional lymph nodes. – Death: Inhalation bronchopneumonia, Death: haemorrhage, cachexia and starvation and asphyxia. asphyxia. Malignant Tumors Malignant Carcinoma of the mouth: – Floor of the mouth. Floor Typical malignant ulcer extend to alveolar process & tongue. tongue. – The cheek: warty and proliferative. – The alveolar process: warty, nodules or proliferative. Malignant Tumors Malignant – Palate: spread extensively before involving bone papillary spread or ulcerative. or – Soft palate and fauces: Soft Poor prognosis. bilateral Lymph node involvement involvement Proliferative, fungating lesion spread to base of Proliferative, tongue. Pain, dysphagia and death due to erosion of carotid artery carotid Malignant Tumors Malignant Malignant neoplasm of antrum: – Squamous cell carcinoma 93% of cases. Squamous – Infiltrate soft tissue, destroys bone, fungate Infiltrate either through cheek, mouth or pharynx. – Spread to deep upper cervical lymph nodes. Adenocarcinoma llympho‑epithelioma ympho‑epithelioma sarcoma rare sarcoma Malignant Tumors Malignant Clinically: – earliest symptom: unilateral sera‑sanguineous discharge or frank unilateral epistaxsis in elderly. unilateral swelling of cheek, buccal sulcus or palate dislodging denture, loose Painful and periostitic teeth &alveolar abscesses teeth Denture hyperplasia or granuloma. Denture Malignant Tumors Malignant Anaesthesia of cheek due to involvement of Anaesthesia infra orbital nerve. Anaesthesia and/or paraesthesia of the palate due to involvement of sphenopalatine ganglion ganglion Malignant Tumors Malignant – Medial spread: occlusion of nasolacrimal duct (epiphora) blocked nostril and blood‑stained discharge of pus – Superior spread: Eye is proptosed and with involvement of Ms & Ns strabismus, limitation of movement, diplopia strabismus, – Trismus due to involvement of medial pterygoid Trismus muscle. – Pain due to secondary infection. ...
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